Silver Diamine Fluoride Treatment Research Articles

Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: A randomized controlled trial

Background This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and casein phosphopeptide-amorphous calcium phosphate fluoride varnish (CPP-ACPFV) in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children. Methods A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or CPP-ACPFV treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed. Results The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and CPP-ACPFV (P-value < 0.05). Similarly, there was a significant difference in caries progression between the two groups (P-value < 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period. Conclusions In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with CPP-ACPFV. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and CPP-ACPFV as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health. Trial registration ISRCTN54243749 (13/01/2022).

Parental acceptability of silver diamine fluoride: The UK and US experiences.

International data suggest that parents may have reservations about the use of silver diamine fluoride (SDF). The aims of this study were to: (1) examine the acceptance of parents/carers towards the use of SDF for the management of caries in children's primary teeth in secondary care dental settings in the UK and the United States and (2) determine which factors may affect the acceptance of the use of SDF. This was a cross-sectional questionnaire of SDF acceptability, completed by parents of young children. It was validated and adapted to local populations. Data were analysed with descriptive and inferential statistics. Of the 113 Sheffield parents, 73% reported that they would accept SDF treatment of children's posterior teeth, with 58% reporting this for anterior teeth. Parents having less concern about posterior aesthetics had a statistically significant effect on reported acceptance of SDF (p = .013). In the Colorado sample (n = 104), 72% reported that they would accept SDF on posterior teeth, and 58% reported that they would accept SDF on anterior teeth. Concerns about aesthetics had an effect on decreasing SDF acceptance overall (p = .0065) in anterior (p = .023) and posterior teeth (p = .108). The majority of parents in the two study populations accepted the treatment using SDF. However, concern about aesthetics had an influence on acceptability.

The Older Adults' Intention to Use Silver Diamine Fluoride for Dental Caries Treatment.

This study aimed to determine the intention of older adults to use silver diamine fluoride (SDF) for treating tooth decay. A group of Thai-speaking individuals between the ages of 60 and 90 were asked to participate in the study. They were provided with information about SDF and then asked to complete a questionnaire based on the Theory of Reason Action (TRA). The questionnaire consisted of 23 questions divided into seven constructs aimed at determining the determinants of the intention to use SDF. These constructs were behavioral belief, evaluation of behavioral outcome, normative belief, motivation to comply, attitude towards behavior, subjective norm, and intention. The responses were rated on a 4-point Likert scale ranging from 1 (Strongly disagree) to 4 (Strongly agree). The characteristics and TRA scores of the participants were analyzed and compared based on their intention to use SDF, using the Chi-square test and t-test. Multiple logistic regression was employed to determine the determinants of the intention to use SDF. The study involved 588 participants, with an average age of 65.3 years (SD= 5.53). Of the participants, 52.7% were women, 58.1% were unemployed or retired, 80.8% lived with family, 63.4% had less than sixth-grade education, 62.9% had a monthly family income of less than 10,000 baht, and 63.6% had underlying diseases. The study found that 82.7% of the participants intended to use SDF for dental caries treatment, with an average score of 2.86 out of 4. The study also found that age, family income, underlying diseases, dental health problems, and fear of the dentist significantly affected their intention. Behavioral beliefs and evaluations of behavioral outcomes significantly affected the intention to use SDF treatment. Most older adults in the study intended to use SDF for dental caries treatment.

Impact of Potassium Iodide Solution on Silver Diamine Fluoride Black Staining - In Vitro Investigation

Dental caries is a prevalent global oral health issue, necessitating effective preventive and treatment strategies. Silver diamine fluoride has emerged as a valuable tool for arresting carious lesions, but its drawback of causing permanent black staining raises concerns. This study explores the potential of potassium iodide to mitigate silver diamine fluoride -induced staining through repeated applications at different intervals. Sixty carious permanent teeth were divided into three groups: silver diamine fluoride alone, silver diamine fluoride with daily potassium iodide application, and silver diamine fluoride with weekly potassium iodide application. Color assessments were conducted using mean grey values at baseline, immediately post-application, and at 2 and 4 weeks. Results demonstrated that potassium iodide significantly reduced black staining when applied immediately after silver diamine fluoride. Daily potassium iodide application yielded the whitest color, surpassing weekly application. The findings suggest that integrating potassium iodide with silver diamine fluoride, particularly through daily application, offers a promising approach to minimize staining associated with silver diamine fluoride treatment, enhancing its acceptability and clinical utility.

Abstract 6035: Fluoride effects on thermal properties of irradiated dentin and enamel

Abstract Aim: Radiation therapy to treat oral cancer introduces various harms, including decreased hardness of dentin and enamel. Fluoride treatments, including silver diamine fluoride (SDF), have been used as a tool to combat these harms, but its influences on the thermal properties of dentin and enamel prior to and after radiation therapy are not well understood. Thus, this study analyzed how SDF influences the thermal stability of dentin and enamel that has been exposed to radiation therapy intended for head and neck cancer patients. Methods: Forty human posterior teeth were collected, cleaned of debris and soft tissue, and then mounted into acrylic resin molds. The teeth were divided into two equal groups, with one group being the control (no treatment) and the other group receiving SDF treatment. Using an X-Rad 320ix biological irradiator, all teeth were subjected to two grays of radiation therapy every day for six weeks. Afterwards, the dentin and enamel were pulverized a SPEX freezer mill. Samples were heated in a NETZSCH Thermal Analysis instrument, and the amount of carbon dioxide and water released was determined. All teeth were heated to 1429 °C from room temperature. Results: The SDF-treated dentin released the most carbon dioxide (49,611.82 ppm/mg), followed by irradiated dentin (47,672.76 ppm/mg) and untreated dentin (45,249.66 ppm/mg). In contrast, the SDF-treated enamel released less carbon dioxide (7,367.62 ppm/mg) than the control enamel (8,172.01 ppm/mg). The pattern of release of water was different from that of carbon dioxide. The control dentin group released the most water (45.56 ppt/mg), followed by the SDF-treated (39.72 ppt/mg) and irradiated dentin (23.51 ppt/mg). Similarly, the control enamel also released the highest amount of water (0.83 ppt/mg), as well as the highest amount of carbon dioxide. The SDF-treated enamel released around 65% of the water compared to the control enamel group (0.54 ppt/mg). Furthermore, the irradiated dentin had the largest heat reversal temperatures for carbon dioxide (85.19 °C) and water (86.57 °C). Conclusions: The impacts of SDF treatment and radiation vary between dentin and enamel. Comparatively, dentin has a higher content of combustible material than enamel. Radiation treatment reduces the water content of both enamel and dentin, which may make teeth more susceptible to fracture. Therefore, regular dental check-ups and frequent fluoride treatment to increase the strength of the teeth are recommended for patients undergoing radiation therapy. Citation Format: Rachel J. Kulchar, Yusuke Kakiuchi, Vania Sanchez-Gamarra, Jie Deng, Francis Mante. Fluoride effects on thermal properties of irradiated dentin and enamel [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6035.

Assessing the Effects and Acceptance of Silver Diamine Fluoride Treatment in Early Childhood Caries.

Early childhood caries (ECC) is a widespread dental problem that impacts children below the age of six years. Traditional restorative treatments like fillings are often challenging and invasive for young children. Silver diamine fluoride (SDF) offers a minimally invasive and cost-effective alternative for managing ECC. However, theeffects, acceptance, and understanding of this treatment by parents remain crucial for its successful implementation. To evaluate the impact and level of acceptance of SDF treatment in ECC. Thirty-two children from an Anganwadi centeraged between two to five yearssuffering from ECC were selected. A 38% SDF was applied for 3 minutes on the identified carious lesion, and the arrest percentage was checked after a recall period of three weeks and three months. The Likert scale was used for the questionnaire regardingparental feedback about the ease of application procedure, tooth discoloration, possible pain associated with the procedure, andthe taste of SDF. In the present study, a total of 75 surfaces were subjected to the application of SDF. After a period of three weeks, it was observed that 64 of these surfaces had successfully undergone the process of caries arrest. This finding was deemed to be statistically significant, with a P value of 0.021. Furthermore, the remaining surfaces that had not achieved caries arrest were subsequently treated atthree months. The results of this subsequent treatment were also found to be statistically significant, with a P value of 0.027. These findings highlight the efficacy of both caries treatment and caries arrest in relation to the utilization of SDF. SDF was found to be minimally invasive, easy to administer, inexpensive, highly efficient, and effective treatment in arresting caries in the primary dentition of young children, particularly in patients lacking cooperation.

Parental satisfaction and acceptance of silver diamine fluoride treatment for molar incisor hypomineralisation in pediatric dentistry: a cross-sectional study

The study aimed to investigate parental satisfaction and acceptance of silver diamine fluoride (SDF) treatment for permanent molars affected by molar incisor hypomineralisation (MIH). This study was conducted in the pediatric dental department at Damascus University, Syria. This study was performed at the period from Jan 2023 to April 2023. In this cross-sectional study, a validated questionnaire employing a 5-point Likert scale was used to evaluate esthetics, ease of application, pain perception, and taste acceptability. Participants included 100 parents or guardians of children aged 6–9 years who had received SDF treatment in the past year. The findings of this study revealed high satisfaction levels (77.5%) with the treatment. Parents expressed contentment with the appearance of their child's molars after SDF application (58% agreed or strongly agreed) and found the application process easy and pain-free (100% agreed or strongly agreed). However, taste acceptability posed a challenge, with over half of the parents (53%) finding it unacceptable. Regression analysis underscored the significant impact of esthetics, ease of application, pain perception, and taste on parental satisfaction. Moreover, parents with higher education levels (graduate or postgraduate) exhibited higher acceptance rates compared to those with lower education levels (63.1% vs. 33.6%). Notably, parental gender and age did not significantly influence SDF treatment acceptance. This study provides critical insights into parental satisfaction and acceptance of SDF treatment for MIH-affected permanent molars. Despite concerns about tooth discoloration, the high satisfaction levels suggest that SDF holds promise as an effective treatment option. Parental education significantly influenced acceptance rates. This research highlights the importance of considering parental perspectives and tailoring communication strategies in pediatric dentistry, ultimately contributing to improved care for young patients with MIH.

Effect of silver diamine fluoride on the longevity of the bonding properties to caries-affected dentine

ObjectivesThis study aimed to evaluate the adhesive properties in dentine after the application of silver diamine fluoride (SDF) on carious dentine lesions immediately and after 2 years of water storage. Methods96 human molars used were subjected to artificial dentine caries production, and then randomly divided into 12 experimental groups according to 1. application of an SDF solution (carious dentine lesion without SDF treatment [control], with 12 % silver diamine fluoride [SDF 12 %] or 38 % silver diamine fluoride [SDF 38 %]); 2. Universal adhesives (Clearfil Universal Bond Quick [CUQ] and Single Bond Universal [SBU]); 3. adhesive strategy (etch-and-rinse [ER] and self-etch [SE]). After restoration, the specimens were sectioned and submitted to the microtensile bond strength test (μTBS) and energy-dispersive X-ray spectrometry analysis (SEM/EDX). All tests were performed immediately and after 2 years of water storage. Data from the μTBS were analyzed using four-way ANOVA and Tukey's test (α = 0.05). ResultsOnly the interaction of factors 'SDF' vs 'time' was significant (p = 0.03). After 2 years of storage, the groups where SDF was applied showed higher μTBS values compared to the control group. No significant decrease in μTBS values was observed for SBU when comparing immediate and 2-year results, but a significant reduction in μTBS values was observed after 2 years for CUQ. ConclusionIndependent of the adhesive strategy, the use of SDF may be a promising alternative to maintain the bonding of universal adhesives to carious dentinal lesions. Clinical significanceThis study may clarify and support clinicians regarding the longevity of resin-based restoration in caries-affected dentine treated with silver diamine fluoride.

Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: A randomized controlled trial

Background This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and Casein Phosphopeptide-Amorphous Calcium Phosphate fluoride Varnish (CPP-ACPFV) in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children. Methods A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or CPP-ACPFV treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed. Results The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and CPP-ACPFV (P-value < 0.05). Similarly, there was a significant difference in caries progression between the two groups (P-value < 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period. Conclusions In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with CPP-ACPFV. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and CPP-ACPFV as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health. Trial registration ISRCTN54243749 (13/01/2022).

Efficacy of 38% silver diamine fluoride in reducing gingival inflammation and plaque accumulation in older adults living in retirement-homes: A randomized controlled pilot trial

ObjectivesEmerging from earlier case reports the potential benefits of 38 % silver diamine fluoride (SDF) in addressing pathogenic biofilms and mitigating gingival inflammation and enlargement have sparked interest. Our study aimed to evaluate the efficacy of 38 % SDF in reducing gingival inflammation and plaque accumulation in older adults living in retirement-homes. MethodsThis 7-week randomized, controlled, double-blinded pilot trial employed a parallel assignment design. The study enrolled older adults (aged ≥65) residing in retirement homes in Dallas County, ultimately comprising a cohort of 40 participants who were evenly divided into two arms. The experimental group received SDF treatment, whereas the comparator group received a placebo. Over three consecutive weeks, both groups had solutions applied to the facial surfaces of all their teeth once per week. The primary outcomes measured the change in Löe-Silness Gingival Index (GI) and Silness-Löe Plaque Index (PI) at 7 weeks following baseline treatment. Repeated measures ANOVA was utilized to assess changes over time within each group (n = 15 each). Post-hoc paired t-tests were conducted to compare changes between week 1 and each subsequent follow-up time point (weeks 3, 5, 7), supplemented with 95 % confidence intervals for change from week 1. ResultsIn the SDF group, within-group comparisons demonstrated significant reductions (adjusted p < .05) in GI scores within 3 weeks (-.93±.37), as opposed to week 1 (1.90±.39). Between-group comparisons unveiled reductions in both mean GI (p < .05) and PI (p < .05), indicating less gingival inflammation and plaque accumulation in the SDF group at all time points, commencing at week 3. ConclusionsThis study showed that 38 % SDF was effective in reducing gingival inflammation and plaque accumulation in older adults living in retirement-homes. Clinical significanceOral health in older adults is a public health concern, especially for the medically compromised or those without traditional care. Our findings offer hope for enhancing oral health quality of life by introducing a cost-effective, compliance-free, noninvasive, and accessible therapeutic. Trial registrationNCT03445286.(clinicaltrials.gov)

Assessment of Antibacterial Effectiveness of SDF and Fluoride Varnish Agents for Application in Pediatric Dentistry

ABSTRACT Objectives: To assess antibacterial effects of silver diamine fluoride (SDF) and fluoride varnish treatment against Streptococcus mutans and Lactobacillus acidophilus Materials and Methods: The antibacterial effectiveness of SDF (group A) and fluoride varnish (group B) against S. mutans was investigated in an in vitro microbiological investigation, with distilled water (group C) serving as the positive and negative controls. After 24 hours of incubation, the antibacterial efficiency was assessed using the agar well diffusion technique, and the diameter of the zones of inhibition (ZOI) was quantified. Sumba mare’s milk from MRS broth was extracted and then placed into a test tube. L. acidophilus was grown on Sumba mare’s milk from MRS broth. On this media, each testing agent was poured and tested for the inhibitory zone. The obtained data was statistically analyzed. Results: SDF group had a higher mean zone of inhibition against S. mutans and Lactobacillus followed by fluoride varnish, and there was no ZOI in the case of distilled water. Intergroup comparison was significant Conclusion: When compared to fluoride varnish, the SDF teeth remineralizing agent had greater antibacterial activity against S. mutans.

Effect of silver diamine fluoride on the microleakage of flowable resin composite and glass ionomer cement restorations to carious primary dentin: an-in vitro study

BackgroundThis study aimed to evaluate the effect of Silver Diamine Fluoride (SDF) on the microleakage of flowable resin composite (FRC) and resin-modified glass ionomer cement (GIC) restorations bound to carious primary dentin.MethodsForty-four extracted carious primary molars were allocated into four groups as follows (n = 11 teeth/group): Group I, Flowable resin composite (FRCa): SDF38% treatment + FRC, Group II, Flowable resin composite (FRCb): FRC without SDF treatment, Group III, Resin-modified glass ionomer cement (GICa): SDF38% treatment + GIC, Group IV, Resin-modified glass ionomer cement (GICb): GIC without SDF treatment. Specimens were subjected to thermo cycling at 500 cycles between 5 to 55 °C (dwell time of 60 seconds) in baths before being immersed for 24 h in a 1% toluidine blue solution. Microleakage testing was conducted for each specimen in two areas; occlusal and gingival. Specimens were evaluated under stereomicroscope at 4x magnification. Results were analyzed using Kruskal-Wallis test followed by pairwise comparisons utilizing Dunn’s post hoc test at p ≤ 0.05.ResultsInsignificant differences between different groups (p = 0.49) were observed at the gingival walls area readings. The highest value was found in GICb (2.33 ± 0.52), while the lowest value was found in FRCa (1.71 ± 0.76). Insignificant differences between different groups (p = 0.982) were observed at the occlusal walls area readings. The highest value was found in FRCa (1.43 ± 0.98), while the lowest value was found in GICb (1.17 ± 1.33).ConclusionSDF does not adversely affect the microleakage of FRC and GIC restorations bound to carious primary dentin.

Antibacterial Effects of Silver Diamine Fluoride with and without Potassium Iodide against Streptococcus mutans.

Silver diamine fluoride (SDF) is a topical treatment for carious lesions and a primary preventative for newly exposed high-risk surfaces such as fissures and roots in the first molars. Using potassium iodide (KI) after applying SDF has been recommended as a way of reducing the severity of black staining, as well as preserving its antibacterial effect useful in deep caries. The objective of this research was to compare the antibacterial effect of SDF, with and without KI, on Streptococcus mutans (S. mutans) and dental biofilm. The antibacterial effects of SDF, KI, and the combination of both were measured using three different techniques (inhibition halo, minimum inhibitory effect [MIE], and colony-forming unit [CFU], testing). The results were then subjected to statistical analysis. Analyzed by means of the Kruskal-Wallis statistical test, the inhibition halos yielded a value of P = 0.3309. Using the MIE test, only the SDF treatment produced an antibacterial effect, at 10%, compared to the KI group, with P = 0.001. Finally, the CFU test revealed a total absence of colonies for all three reagents. All three substances analyzed achieved total inhibition of S. mutans. SDF is effective even in its minimal commercial concentration. Its antibacterial capacity decreases with the addition of KI. The three substances analyzed at their maximum concentrations exhibited an antibacterial effect against S. mutans, resulting in total inhibition.

Acceptance of silver diamine fluoride use in community dwelling older adults, nursing home residents, and caregivers

ObjectivesTo compare the level of acceptance of silver diamine fluoride (SDF) treatment between different functional groups of older adults aged 65-years-old and above. MethodsThree groups were recruited representing functionally-independent (“Community dwelling”), frail (“Nursing home”), and functionally-dependent older adults (“Caregiver”: proxy respondent involved in caring for an older adult of all functional levels). Participants viewed a video on SDF and an interviewer-led questionnaire collected demographics, dental experience and perception on SDF use. ResultsThe study recruited 201 participants (100 “Community dwelling”, 51 “Nursing home”, 50 “Caregiver”). Overall, 73 % of participants were accepting of SDF treatment. Those in the “Community dwelling” group were most accepting (85 %), followed by the “Nursing home” group (61 %) and “Caregiver” group (60 %) (p<0.001). Participants were more accepting of SDF use on posterior (73 %) compared to anterior teeth (46 %). They were more accepting when SDF was presented as a treatment to avoid infection and pain (87 %), and general anesthesia (78 %). In a regression analysis, “Nursing home” and “Caregiver” participants were three times less likely to accept SDF (OR 0.27 [95 % CI: 0.13 to 0.60], and OR 0.27 [95 % CI: 0.12 to 0.58] respectively) compared to “Community dwelling” participants. After adjusting for other factors, only the “Caregiver” group remained significant (Adjusted OR 0.32 [95 % CI: 0.13 to 0.78]). ConclusionsOlder adults were accepting of SDF and this treatment modality has the potential to be a routine treatment option in dental caries management in this population. However, this was less certain among frail and functionally dependent older adults. CLINICAL SIGNIFICANCEAn SDF program to manage caries is likely to be well-received by functionally-independent older adults. However, the acceptance among frail and functionally-dependent older adults were lower even though SDF is mostly likely to benefit these populations. There is a need to investigate this relatively lower levels of acceptance.

Acceptability of Silver Diamine Fluoride

Background: Silver diamine fluoride (SDF) can be used for active carious lesions in primary teeth and can be applied in dental clinics, in school, or in community-based settings with simple armamentarium and minimal support. Silver diamine fluoride causes darkening of carious enamel and dentin after its application. Method: An electronic literature search in Web of Science, Scopus, Science Direct, PubMed, Google Scholar, African Journal Online, Researchgate, and Google was done in June 2023. Search terms and keywords were combined by Boolean operators. Four independent investigators (research assistants) screened titles, abstracts, and full text of publications. The inclusion criteria were original research articles ( human studies) carried out in African regions and including observational studies (cohort, case-control, cross-sectional), experimental studies (clinical trials, randomized or not) designs, case reports, and case series investigating parents, caregivers, guardians or children acceptability or acceptance of silver diamine fluoride treatment procedure and post-treatment blackening/staining of teeth. Systematic reviews and review articles were excluded. Results: One article was included as it was assessed to meet the aim of the review. It was a hospital-based study. Parental acceptance of silver diamine fluoride treatment with its black staining was assessed using the Likert scale. Acceptance of post-treatment staining of teeth among parents was higher in posterior teeth than in anterior teeth. Conclusion: Only one study on the acceptability or acceptance of silver diamine fluoride treatment procedure and post-treatment staining of teeth was identified among African parents. More studies from the diverse ethnic population in Africa will contribute to the existing literature. J Rang Med Col. September 2023; Vol. 8, No. 2: 53-55

Material of choice for non-invasive treatment of dentin caries: An in vitro study using natural carious lesions.

In community settings with limited dental personnel and equipment, and in an era when the aerosol transmission of infectious agents is on the rise, a non-invasive approach to caries management is critical. To provide information on non-invasive material selection, the aim of this study was to compare the remineralization effect of commonly used fluoride-containing materials, adjunctive to the everyday use of fluoride toothpaste (F-toothpaste), on primary tooth natural dentin caries. Fifty-five specimens were randomly divided into five groups: 38% silver diamine fluoride (SDF), 5% fluoride varnish (F-varnish), glass-ionomer cement (GIC), deionized water (DW) with F-toothpaste slurry, and DW as a control group (n = 11). The lesion depth and mineral density were measured before and after bacterial pH-cycling using micro-computed tomography. The percentage of mineral density change (%MDchange) was quantified. The dependent t-test, Wilcoxon-Signed-Rank Test, and one way ANOVA with Bonferroni correction were used to analyse the data. SDF application reduced lesion depth from 844.6 to 759.1 μm (p < 0.045) while increasing mineral density from 551.4 to 763.0 mgHA/cm3 (p < 0.003). Only mineral density rose from 600.2 to 678.4 mgHA/cm3 (p < 0.013) when GIC was used. The other groups showed no difference. The highest %MDchange was also found after SDF treatment (49.7%, p < 0.05), whereas GIC (17.2%, p < 0.05) presented a higher percentage than the F-varnish (2.0%), F-toothpaste (-1.1%) and no-treatment groups (-1.4%). In this in vitro study, where the pH of cycling was almost neutral, using SDF as an adjunct to F-toothpaste resulted in the highest remineralization compared with other remineralizing materials.

Silver Diamine Fluoride Staining With Potassium Iodide: A Prospective Cohort Study

Staining after silver diamine fluoride (SDF) treatment limits treatment acceptability but is also used as a clinical indicator of lesion stability. Potassium iodide (KI) has been postulated to modify SDF staining. Understanding the natural history and resultant shade of SDF/KI-treated lesions will inform clinical decision-making. This study describes the change in colour of carious lesions in primary teeth treated with SDF and KI. One hundred carious lesions in primary teeth were treated with SDF+KI (Riva Star, SDI) and followed up over 6 months. Lesion shade was determined using standardised intraoral photography and broadly categorised into 4 shades: yellow, light brown, dark brown, and black. Lesions were digitally isolated, and colour was evaluated using CIELAB (L*: lightness, a*/b*: hue) and perceptible colour change (ΔE). One hundred valid observations were analysed on 129 lesions included in the study. Lesions were excluded if subsequently restored (n=15), teeth exfoliated (n=2), exhibited pulpal exposure (n=1), or failed to attend at follow-up visits (n=11). At baseline, the shade of carious lesions was yellow (n=22), light brown (n=19), dark brown (n=29), or black (n=30). The changes in shade between baseline and 6 months were clinically perceptible to the human eye, with the mean ΔE being 12.2 (SD=6.9). Neither tooth type, lesion severity, nor baseline shade was statistically associated with the degree of perceptible change at 6 months. Carious lesions exhibited clinically significant changes in colour after application of SDF+KI, primarily attributed to differences in L* of lesions over the 6 months.

Preventive efficacy of silver diamine fluoride and MI Varnish on molars affected by molar incisor hypomineralization in children: A randomized controlled trial

Background: This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and MI Varnish in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children. Methods: A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or MI Varnish treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed. Results: The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and MI Varnish (P-value &lt; 0.05). Similarly, there was a significant difference in caries progression between the two groups (P-value &lt; 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period. Conclusions: In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with MI Varnish. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and MI Varnish as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health. Trial registration: ISRCTN54243749 (13/01/2022).

The effect of silver diamine fluoride on the microleakage of glass ionomer restoration in primary teeth at different time intervals

Silver diamine fluoride (SDF) has shown effectiveness in hardening tooth structure and killing bacteria. Therefore, it can be used to prevent and arrest dental caries. Riva Star (SDF) treatment alone will stop cavities but will not reverse the cavitation. The Silver Modified Atraumatic Procedure, often known as Smart, is the optimum technique for regaining the tooth's structure and function. Glass ionomer was introduced in (1972) as a new material that has become one of the most widely used materials in restorative dentistry. By releasing fluoride ions, this material has a therapeutic impact on the surrounding tooth structure. Microleakage is the ingress of bacteria, its byproducts, toxins, chemicals, oral fluids, and ions between the margins of the restoration and the cavity walls. Dental restoration lifetime is significantly influenced by microleakage at the toothrestoration contact. Material and method: In this study, we used 32 primary molars, class V cavities prepared on the buccal surface of all teeth. The teeth were divided into 2 groups: Group 1: 16 teeth treated with 38%SDF 8 of them restored directly with GIC filling and the other 8 restored after 14 days; Group 2: 16 teeth as control group left untreated with 38% SDF,8 teeth restored directly and 8 restored after 14 days. Samples were thermocycled, immersed in 2% methylene blue and then sectioned in a buccolingual direction. Dye penetration was measured with a digital camera connected to a stereo microscope. Result: results of this study showed a significant difference in microleakage between two-time intervals in which microleakage in GIC filling decreased at 14-day intervals than that of first-day interval in the experimental group, while in the control group, microleakage at 14 days intervals was higher than first-day interval, but it was not significant. Conclusion: Pretreatment of the primary teeth with SDF can decrease the microleakage of GIC restoration. If placed after 14 days, the microleakage would be lesser than that if the restoration was placed directly after SDF treatment. Therefore, it is recommended that SDF treatment be done, followed by a permanent restoration after 14 days, so the null hypothesis cannot be accepted. Keywords: Microleakage, Silver diamine fluoride, Glass ionomer filling, noninvasive dentistry

The Caries-Arrest Effectiveness of Silver Diamine Fluoride Treatment with Different Post-Treatment Instructions in Preschool Children: A Study Protocol for a Randomized Controlled Trial.

In this 12-month randomized active-controlled clinical trial, we compare two post-treatment instructions for silver diamine fluoride (SDF) therapy in arresting dentine caries. The trial will include at least 254 kindergarten children with active dentine caries. The children will be randomized into two groups and receive a 38% SDF solution applied topically to their carious lesions. Children in Group A will rinse immediately, whereas those in Group B will refrain from rinsing, eating, and drinking for 30 min. One trained examiner will perform the dental examination at baseline and every six months. The primary outcome measurement will be the proportion of caries lesions that become arrested at the 12-month examination. Potential confounding factors and parents' satisfaction with SDF therapy at baseline and after 12 months will be collected using parental questionnaires. This trial will provide evidence-based information for clinical practitioners to give post-treatment instructions for SDF therapy. This study is registered at ClinicalTrial.gov (USA) (registration number: NCT05655286).